Complete Text (Part 6)

of Liver. See Abscess of lAver, page 78. Cancer of Liver. Hydatids of Liver. 1. Pain severe. i. No pain. 2. Liver nodules hard. 2. Liver tumors soft, smooth and elastic. DISEASES OF THE LIVER. 83 NAME OF DISEASE. Cancer of Liver. 3. No percussion fremitus. 4. Severe gastric symptoms. 5. Disease rapid in development. 6. Exploring needle withdraws blood. Cancer of Liver. 1. Hepatic symptoms appear first 2. No vomiting of blood. 3. Gastric symptoms not increased by taking food. 4. Absolute dulness over the tumor. 5. Tumor multiple. 6. Tumor stationary. Cancer of Liver. 1. Gastric symptoms well marked. 2. Urine normal. 3. Outline of dulness corresponds to the shape of the liver. 4. Area of dulness not bounded by a tympanitic resonance. 5. Tumor lowered by a deep inspira- tion. 6. Disease of adults. DISEASES TO BE DIFFERENTIATED. Hydatids of Liver. 3. Hydatid frem.itus on percussion. 4. No gastric disturbance. 5. Slow progress of disease. 6. Exploring needle withdraws fluid containing booklets. Cancer of Stomach. 1. Gastric s)Tiiptoms are the first to appear. 2. Hematemesis. 3. Symptoms often increased by tak- ing food. 4. Tympanitic quality to the tumor dulness. 5. Tumor single. 6. Tumor movable. Cancer of Kidney. 1. No well-marked gastric disturb- ance. 2. Urine contains blood. 3. Outline of dulness corresponds to the shape of the kidney. 4. Area of dulness is bounded by tympanitic resonance. 5. Tumor stationary. 6. disease of children or adults. Hydatids of Liver. Cancer of Liver. See Cancer of Liver, page 82. Hydatids of Liver. Abscess of Liver, See Abscess of Liver, page 78. 84 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Hydatids of Liver. Abdominal Aneurism. See Abdominal Anezirism, page 46. Eniarared Gall Bladder. Hydatids of Liver. 1. History of eating raw meat. 2. Tumor multiple. 3. Tumor globular. 4. Tumor readily manipulated. 5. Hydatic fremitus on percussion. 6. Exploring needle withdraws fluid containing booklets. Hydatids of Liver. 1. Tumor grows from above down- ward. 2. Tumor rises and falls with respira- tion. 3. Colon lies behind tumor. 4. Hydatid fremitus on percussion. 5. Ilooklets found in aspirated fluid from tumor. Hydatids of Liver. 1. History of jaundice or hepatic colic. 2. Tumor single. 3. Tumor pear-shaped. 4. Tumor not readily manipulated. 5. No fremitus on percussion. 6. Exploring needle withdraws bile. Cyst of Kidney. 1. Tumor grows from below upward. 2. Tumor stationary. 3. Colon lies in front of tumor. 4. No fremitus on percussion. 5. Aspirating needle withdraws albu- minous fluid containing chlorides. Ascites. See Ascites, page 72. Perihepatitis. Abscess of Liver. See Abscess of Liver, page 79. Perihepatitis. Begins with a chill. i. Temperature 100^ to 102°. 2. No distinct points of tenderness. 3. No history of neuralgia. 4. Pain not limited to an intercostal 5. space. Intercostal Neuralgia. Begins with shooting pain in side. Temperature normal. Three distinct points of tenderness. History of neuralgia. Pnin limited to an intercostal space. DISEASES OF THE LIVER. 85 NAME OF DISEASE. Perihepatitis. 6. Pain increased by pressure upward under ribs. 7. No herpetic eruptions. Perihepatitis. 1. Slight dyspnoea. 2. Pain increased by pressure upward under ribs. 3. Fain most severe below fourth rib. 4. Pulmonary physical signs normal. 5. No cough. DISEASES TO BE DIFFER.ENTIATED. Intercostal Neuralgia. 6, Pain not increased by pressure up- ward under ribs. 7. Herpes zoster common. Acute Pleurisy. 1. Dyspnoea v/ell marked. 2. Pain not increased by pressure, but by respiration. 3. Pain most severe above fourth rib. 4. Diminished vocal fremitus, dulness on percussion, and sticky rales. 5. Teasing dry cough. Hepatic Colic. Intestinal Colic. See Intestinal Colic, page 67. Hepatic Colic. Acute Peritonitis. See Acute Peritonitis, page 69. Hepatic Colic. 1. Pain shoots from gall bladder to back. 2. Urine contains bile pigment, Fseces clay-colored. Stools contain gall-stones. Urine voided naturally. Gall bladder remains tender on pressure. Hepatic Colic. 1. Attack comes on at any time. 2. Pain shoots from gall bladder to back. 3. Pain ceases suddenly. 4. Urine contains bile pigment. 5. Faeces clay-colored. Renal Colic. 1. Pain shoots along ureter to testicle or penis. 2. Urine contains blood. 3. Fcsces normal color. 4. Urine contains gravel. 5. Urine passed every few minutes. 6. Sharp pain follov/ed by a dull ach- ing in loins. Cardialgia. 1. Attack comes on after eating. 2. Pain confined to epigastric region. 3. Pain stops gradually. 4. Urine normal. 5. Normal color of fseces. 86 DIFFER EN TIA L DIA GNOSIS. NAME OF DISEASE. Hepatogenous Jaundice. 1. Occurs with gastroduodenitis, ca- tarrh of bile ducts, etc. 2. Urine contains bile coloring mat- ter. 3. No albumen in urine. 4. Fasces clay-colored. 5. Heart slov/ and regular. 6. No severe nervous symptoms. 7. Itching of skin. 8. Liver increased in size. g. Jaundice well marked. 10. Slight loss of flesh. DISEASES TO BE DIFFERENTIATED. Hematogenous Jaundice. 1. Occurs v/ith fevers, blood dis. eases, etc. 2. Urine contains bile acids. 3. Urine albuminous. 4. Faeces dark color. 5. Heart rapid and irregular. 6. Nervous symptoms well marked 7. Small hemorrhages in skin. 8. Spleen usually enlarged. g. jaundice slight. 10. Rapid emaciation. Hepatogenous Jaundice. Acute Yellow Atrophy. See Acute Yellow Atrophy^ P^^ge 81. Hepatogenous Jaundice. Acute Congestion of Liver. See Acute Congestion of Liver, page 77. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE KIDNEYS AND BLADDER. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE KIDNEYS AND BLADDER. NAME OF DISEASE. Uraemia * • • • • Acute Bright's . Large White Kidney (Chronic Bright' s) Cirrhotic kidney (Chronic Bright's) Fatty or waxy kidney (Chronic Bright's) Bright's disease (dropsy) . DISEASES TO BE DIFFERENTIATED, ' Epilepsy. Apoplexy. Hysteria. Meningitis. Opium poisoning. . Alcoholic coma. Congestion of the kidneys. Hematinuria. Suppurative nephritis. Acute cystitis. Chronic Bright's. Acute Bright's. Cirrhotic kidney. Fatty or waxy kidney. Acute Bright's. Large, white kidney. Fatty or waxy kidney. Acute Bright's. Cirrhotic kidney. Large white kidney. Dropsy due to other causes. 89 90 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Pyelitis .... Pyonephrosis . . Suppurative nephritis Hematuria . . Hematinuria Hydronephrosis, or hydatids Cancer of kidney , , Perinephritic abscess , Renal calculi . . , DISEASES TO BE DIFFERENTIATED. Suppurative nephritis. Cystitis. Perinephritic abscess. Hydronephrosis. Pyelitis. Pyoemia. Perinephritic abscess. Acute Bright's. Cystitis. Hemorrhage from bladder. Hemorrhage from urethra. Acute Bright's. Hematuria. Hydatids of kidney. Ovarian cyst. Pyonephritis. Cancer of kidney. Perinephritic abscess. Hydatids of liver. ' Perinephritic abscess. Tumor of liver. Tumor of spleen. Abdominal aneurism. Hydronephrosis, or Hydatids. Tubercle of kidney. Pyonephritis. Suppurative nephritis. Cancer of kidney. Hydronephrosis. Acute peritonitis. Hepatic colic. Intestinal colic. DISEASES OF THE KIDNEYS AND BLADDER. 91 NAME OF DISEASE. Cystitis ' Uraemia. 1. History of Bright's disease. 2. CEdema. 3. Convulsions migratory in charac- ter. 4. No change in pupils. 5. No biting of tongue. 6. Waxy countenance. 7. Albumen and casts in urine. 8. Temperature low. g. Deep coma follows convulsions. 10. No initial cry or pallor. Uraemia. 1. History of Bright's disease. 2. Coma follows convulsions. 3. Stertor sharp and hissing. 4. No paralysis. 5. Urine albuminous vnth casts. 6. Pupils normal. 7. General oedema. 8. Patient has a uriniferous smell. Uraemia. History of Bright's. Convulsions appear without warn- ing and follov/ed by coma. Peculiar stertor. 4. Casts and albumen in urine. 5 Reflexes absent. 3. DISEASES TO BE DIFFERENTIATED. Acute Bright's. Pyelitis. Suppurative Nephritis. Spasm of the bladder. Epilepsy. 1. Histor}- of epilepsy. 2. No general oedema. 3. Convulsions general — tonic then clonic. 4. Dilated pupils follow spasm, 5. Tongue bitten. 6. Countenance cyanotic. 7. Urine nonnal. 8. Temperature elevated. 9. isiild coma or sleep. 10. Initial cry and pallor. Apoplexy. 1. Histor}^ of disease of arteries, heart, or of injury. 2. Coma precedes convulsions. 3. Stertor labored and snoring. 4. Paralysis and spasm of one side. 5. Urine normal. 6. Pupils unequal. 7. No oedema. 8. No smell about patient. Hysteria. 1. History of hysteria. 2. Coma alternates with convulsions and other hysterical symptoms. 3. Breathing free from stertor. 4. Urine pale and abundant. 5. Reflexes pale or exaggerated. 92 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Uraemia. 6. Opisthotonos rare. 7. Cervical vessels distended. 8. Moral treatment has no effect. Uraemia. 1. History of Bright's. 2. General oedema. 3. Pulse rapid. 4. Waxy countenance. 5. Temperature highest at first. 6. Convulsions migratory in charac- ter. 7. Odor of urine about patient. 8. Albumen and casts in urine. 9. Delirium usually mild or absent. Uraemia. 1. History of Bright's. 2. Comaprecededby other symptoms. 3. Respiration hurried. 4. Pupils normal. 5. Casts and albumen in urine. 6. CEdema. 7. Smell of urine about patient. 8. Skin dry and waxy in appearance. Uraemia. 1. History of Bright's. 2. Cannot be aroused. 3. Albumen and casts in urine. 4. Uriniferous smell about patient. 5. Face vi^axy. 6. QEdema. 7. Stertor hissing in character. DISEASES TO BE DIFFERENTIATED. Hysteria. 6. Opisthotonos common. 7. No distended veins. 8. Moral treatment curative. Meningitis. History of injury or disease. No oedema. Pulse slow. Flushed face. Temperature rises from day to day 7. No odor about patient. 8. Urine normal. 9. Wild delirium. Opium Poisoning. 1. No previous histor}^ 2. Coma comes on gradually like sleep. 3. Respiration slow. 4. Pupils contracted. 4. Urine normal. 6. No oedema. 7. Often smell of opium in breath. 8. Profuse sweating, countenance cy- anosed. Alcoholic Coma. 1. History of alcoholism. 2. Aroused momentarily by pain. 3. Urine contains alcohol. 4. Smell of alcohol in breath. 5. Face flushed. 6. No oedema. 7. Stertor "puffy" in character. DISEASES OF THE KIDNEYS AND BLADDER. 93 NAME OF DISEASE. Acute Bright's Disease. 1. History of acute disease, expos- ure to cold, etc. 2. Severe constitutional symptoms as headache, vomiting, etc. 3 High specific gravity of urine, 4. Urine very albuminous. 5. Casts in urine. 6. Urine bloody. 7. Temperature elevated. 8. Dropsy well marked. Acute Bright's. 1. Dropsy. 2. Disease lasts for some time. 3. Small amount of blood in urine. 4. Severe constitutional symptoms. 5. No granular pigment in urine. 6. Much albumen and many casts in urine. Acute Bright's. 1. Affects both kidneys. 2. Casts abundant. 3. Pus small in amount. 4. Kidneys not enlarged. 5. Continued fever. 6. Severe backache. 7. Dropsy. Acute Bright's. 1. Pain in back. 2. Pain not very severe. 3. Slight pain in passing water. DISEASES TO BE DIFFERENTIATED. Congestion of Kidney. I. History of venous obstraction. 2. No severe constitutional symp- toms. 3. Specific gra\dty of urine normal. 4. But little albumen in urine. 5. No casts in urine. 6. No blood in urine. 7. Temperature normal. 8. No general oedema. Hematinuria. 1. No general oedema. 2. Disease of short duration. 3. Blood in large amount. 4. No severe constitutiona,l disturb- ance. 5. Granular pigment in urine. 6. But little albumen and few blood- casts in urine. Suppurative Nephritis. 1. Affects one kidney. 2. Casts few and covered with pus. 3. Large amount of pus in urine. 4. Affected kidney enlarged and ten- der. 5. Fever remittent. 6. Pain localized over one kidney. 7. No general oedema. Acute Cystitis. 1. Pain over bladder and in penis. 2. Pain sharp and burning. 3. Burning pain on urinating. 94 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Acute Bright's. 4. Albumen large in amount. 5. But little pus and mucus in urine. 6. Urine bloody. 7. Casts in urine. 8. Dropsy. 9. Constitutional marked. symptoms well DISEASES TO BE DIFFERENTIATED. Acute Cystitis. 4. But little albumen in urine. 5. Much ropy pus and mucus in urine. 6. Bloody urine uncommon. 7. No casts in urine. 8. No general oedema. 9. Less severe constitutional disturb- ances. Acute Bright's. Chronic Bright's. See Chronic Btighfs, pages 94, 95, 96. Large White Kidney. (Chronic Bright's.) 1. Usually the result of acute Bright's. 2. Heart hypertrophied. 3. Urine normal, or slightly increased in amount. 4. Casts — ^hyaline, granular, and epi- thelial. 5. Specific gravity of urine dimin- ished. 6. No blood in urine. 7. Temperature normal. Large White Kidney. 1. Dropsy well marked. 2. Most common in young adults. 3. Amount of urine normal, or slightly increased. 4. Epistaxis and retinitis uncommon. 5. Specific gravity of urine, loio- 1018. Acute Bright's. 1. Usually the result of exposure to cold or some acute disease. 2. Heart nonnal. 3. Urine diminished in amount. 4. Blood and a few hyaline casts in urine. 5. Specific gravity of urine increased. 6. Urine bloody. 7. Temperature elevated. Cirrhotic or Atrophied Kidney. 1 . Little or no general oedema. 2. The nephritis of adults. 3. Amount of urine greatly in- creased. 4. Epistaxis and retinitis common. 5. Urine low specific gravity, 1005- lOIO. DISEASES OF THE KIDNEYS AND BLADDER. 95 NAME OF DISEASE. Large White Kidney. 6. Many casts in urine. 7. Liver normal size. 8. Much albumen in urine. Large White Kidney. I. Usually the result of acute Bright's. Dropsy comes on rapidly. Ursemic symptoms common. Liver and spleen normal size. Diarrhoea unfrequent. Casts : hyaline, granular, and epi- thelial. Face pale. Cirrhotic Kidney. (Chronic Bright's.) d^dema slight. Disease of slov/ progress. Urine increased in amount. Urine of low specific gravity. No blood in urine. 6. Few casts — hyaline and granular. 7. No acute symptoms at first. DISEASES TO BE DIFFERENTIATED. Cirrhotic or Atrophied Kidney. C. Few casts, principally hyaline. 7. Liver small. 8. Little or no albumen in urine. Fatty or Waxy Kidney. 1. Follows v/asting disease and sup- puration. 2. Gradual development of oedema. 3. Uraemic symptoms uncommon. 4. Liver and spleen enlarged. 5. Obstinate diarrhoea. 6. Fatty and waxy casts in urine. 7. Face wax-like. Acute Bright's. 1. Dropsy well marked. 2. Disease rapid in progress. 3. Urine diminished in amount. 4. Specific gravity of urine high. 5. Bloody urine. b. Blood and hyaline casts. 7. Symptoms acute from the begin- ning. Cirrhotic Kidney. Large White Kidney. See Large White Kidney, page 94. Cirrhotic Kidney. 1. History of previous good health. 2. Little or no dropsy. 3. Liver small. Fatty or Waxy Kidney. 1. History of wasting disease or sup puration. 2. Qidema well marked. 3. Liver large. 96 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cirrhotic Kidney. Specific gravity of urine 1,005 to 1,010. But little albumen in urine. Few hyaline and granular casts. Sallow complexion. Fatty or Waxy Kidney. DISEASES TO BE DIFFERENTIATED. Fatty or Waxy Kidney. . Specific gravity of urine 1,010 to 1,015. . Much albumen in urine. . Fatty and waxy casts. , Waxy countenance. Large White Kidney. See Large White Kidney, page 95. Fatty or Waxy Kidney. Cirrhotic Kidney. See Cirrhotic Kidney, above. Fatty or Waxy Kidney. (Chronic Bright's.) History of wasting disease or sup- puration. Symptoms appear slowly. Urine increased in amount. No blood in urine. Fatty and waxy casts. Ursemic symptoms rare. Temperature normal. Specific gravity of urine low. Bright's Disease. (Dropsy.) Dropsy usually begins in the feet. Urine contains albumen and casts. Complexion pale, sallow, or waxy. Urine altered in amount or color. Urine altered in specific gravity. No pulmonary symptoms. Pain in region of kidneys. Unemic symptoms. Acute Bright's. 1. History of exposure to cold or some acute disease. 2. Symptoms come on rapidly. 3. Urine diminished 4. Bloody urine. 5. Blood and hyaline casts. 6. Uraemic symptoms common. 7. Temperature elevated. 8. High specific gravity of urine. Dropsy Due to Other Causes. I. Dropsy begins in the face or as ascites. Urine normal. Complexion cyanotic or cachectic. Urine normal in color and amount. Specific gravity of urine normal. 6. Pulmonary or liver symptoms com- mon. 7. No pain over kidneys. 8. Absence of uroemic symptoms. DISEASES OF THE KIDNEYS AND BLADDER. 97 NAME OF DISEASE. Pyelitis. 1. Constitutional symptoms not very prominent. 2. No recurring chills or fever. 3. No diarrhoea. 4. No typhoid symptoms. 5. Characteristic "tailed" cells in urine, 6. No tubal pus casts in urine. 7. Much pus constantly in urine. 8. Now and then irregular nephritic enlargement (pyonephritis). Pyelitis. 1. Pain in lumbar region. 2. Urine acid. 3. Large quantities of pus in urine. 4. " Tailed " cells in urine. 5. No constant desire to urinate. 6. Much foreign matter in urine. 7. Little mucus in urine. 8. No pain during micturition. Pyonephrosis. 1. Pus, blood, and mucus in urine. 2. Temperature nearly normal. 3. No pain on motion. 4. " Tailed " cells in urine. 5. Irregular chills and sweating un- common. 6. Tumor appears and disappears suddenly. 7. No signs of inflammation over tumor. DISEASES TO BE DIFFERENTIATED. Suppurative Nephritis. 1. Constitutional symptoms severe. 2. Recurring chills and fever. 3. Diarrhoea common. 4. Typhoid symptoms. 5. No characteristic cells in urine. 6. Pus casts of renal tubes in urine. 7. Pus in urine inconstant and in small amount. 8. Kidney constantly enlarged and tender. Cystitis. 1. Pain over bladder and in penis. 2. Urine alkaline. 3. But little pus in urine. 4. No characteristic cells in urine. 5. Constant desire to urinate. 6. But little foreign matter in urine. 7. Urine contains large quantities of ropy mucus. 8. Burning pain on passing M'ater. Perinephritic Abscess. 1. Urine normal. 2. Temperature elevated. 3. Severe pain on motion. 4. No characteristic cells in urine. 5. Irregular chills and profuse sweat- ing at intervals. 6. Tumor constant. 7. Severe pain and some oedema over tumor. 98 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Pyonephrosis. 1. Urine contains much pus, etc. 2. " Tailed " cells in urine. 3. Moderate constitutional symptoms, as pain, debility, etc. 4. Indistinct fluctuation of turnor. 5. Aspirating needle withdraws pus, etc. DISEASES TO BE DIFFERENTIATED. Hydronephrosis. 1. Urine normal. 2. No cells in urine. 3. General health good. 4. Distinct fluctuation of tumor. 5. Aspirating needle withdraws wa- tery urine. Suppurative Nephritis. See Pyelitis, page 97. Pyelitis. Suppurative Nephritis. Acute Bright's. See Acute Bright's, page 93. Suppurative Nephritis. No profuse sweating. Urine purulent and bloody. Temperature moderately high. No joint aficctions. No pulmonary symptoms. Affected kidney enlarged and tender. 7. Severe lumbar pains. Suppurative Nephritis. T. Urine bloody and purulent' 2. No distinct renal tumor. 3. Pus casts in urine. 4.